Are synthetic nicotine brands following FDA marketing guidelines?

By Dr. Sushama R. Chaphalkar, PhD.Reviewed by Danielle Ellis, B.Sc.Sep 18 2024

87% of sampled Instagram posts did not adhere to FDA health warning requirements in tobacco promotions

In a recent study published in JAMA Network Open, researchers from the United States of America examined Instagram posts from synthetic nicotine e-cigarette brands to assess their compliance with the Food and Drug Administration’s (FDA’s) health warning guidelines and the impact on user engagement. They found that only 13% of posts complied with FDA health warning guidelines. The posts with warnings had lower user engagement, especially in the form of comments.

Background

Synthetic nicotine products, introduced in 2020, have become increasingly popular, now making up nearly two-thirds of vape shop offerings in the US. Although little is known about their health effects, synthetic nicotine is similar to tobacco-derived nicotine and poses similar addictive risks, especially to youths. Regulatory loopholes allowed synthetic nicotine to evade FDA oversight until 2022, enabling manufacturers to promote flavored e-cigarettes, which appeal to young users.

Social media platforms like Instagram are heavily used for marketing these products, with colorful graphics and misleading claims implying they are safer. This exposure increases youths' willingness to try e-cigarettes, raising public health concerns due to nicotine's negative effects on brain development and potential progression to combustible tobacco use. Current federal regulations on tobacco warnings do not adequately address the challenges posed by social media marketing to teens, who are frequent users of platforms like Instagram.

In the present study, researchers analyzed the promotional content from synthetic nicotine brands on Instagram, a key platform for information sharing and socialization among the youth. They examined the compliance of these posts with FDA health warning guidelines and studied their user engagement.

About the study

The study sample comprised 25 synthetic nicotine brand accounts on Instagram, analyzed over 14 months between 2021 and 2022. The included synthetic nicotine brand accounts were required to be active on Instagram and share at least one promotional post during the study period.

The analysis was limited to the first image of carousel posts, posts with hidden likes or insufficient engagement time, and those with undetectable warning areas were excluded. A total of 2,120 posts were analyzed. To confirm brand ownership, profile images were compared to logos from official websites; 76% linked directly to Instagram.

Data collection included 2,184 images and videos. Posts were coded for product flavors and vaping cues, achieving high intercoder reliability (mean Gwet agreement coefficient = 0.94). The warning label multi-layer image identification (WaLi) algorithm was used to detect health warnings, showing 99% accuracy in identifying warning presence, with a recall of 98% and a precision of 100%. Statistical analysis involved the use of negative binomial regression models adjusted for follower counts, post age, and business account status, with random effects by brand.

Results and discussion

About 52% of accounts restricted access to users under 21 years of age, with 13 of them classified as business accounts. While 96% of accounts used a consistent brand logo, only 16% featured health warnings in their profiles. Further, about 74% of the studied posts promoted flavored products, with a significant majority (72%) not featuring people and 21% including vaping cues. Health warnings were detected in 45% of posts, but only 13% were found to adhere to FDA guidelines.

User engagement metrics showed a mean like count of 46.8 and a mean comment count of 3.8 across all posts. Posts with health warnings garnered fewer comments (1.8 vs. 5.4; P < 0.001) but did not significantly impact the number of likes. Posts promoting flavored products received more likes and comments than non-flavored posts.

For posts with health warnings, a larger warning area correlated with fewer comments (P = 0.003), while the placement of warnings in the upper portion of the image did not significantly influence engagement metrics.

In flavored product posts, the inclusion of a health warning was again found to be linked to fewer comments (P = 0.002). However, increased likes were noted for warnings placed in the upper portion of the image (34.6 vs. 19.9 likes; P = 0.02).

Although the study provides valuable insights with implications for public health, it is limited by potential biases from using social media data, lack of generalizability to other products or platforms, and the inability to know users' age or tobacco use status while only analyzing engagement metrics without assessing the sentiment or specific language of health warnings.

Conclusion

In conclusion, the study highlighted that most Instagram posts by synthetic nicotine brands failed to comply with regulations requiring health warnings.

Posts with health warnings, especially larger ones, saw reduced user engagement, suggesting that proper warnings may discourage youth from interacting with and potentially using synthetic nicotine products.

The findings highlight a gap in regulatory enforcement and emphasize the benefits of strict compliance to protect young people from nicotine addiction.